Healthcare Provider Details

I. General information

NPI: 1093630931
Provider Name (Legal Business Name): SOFIA RICARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 SW 80TH ST STE 121
SOUTH MIAMI FL
33143-4661
US

IV. Provider business mailing address

14120 SW 78TH ST
MIAMI FL
33183-3018
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-4833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: